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Quick Facts

The mission of VBAC Facts is simple: to make hard-to-find, interesting, and pertinent information relative to post-cesarean birth options easily accessible to the people who seek it.  VBAC Facts does not advocate for a specific mode of delivery, birth attendant or birth location.

After a cesarean, most women have two choices for future births: a vaginal birth after cesarean (VBAC) or a repeat cesarean section (RCS). There is a lot of misinformation about these two options. Let’s review some quick facts.

Per the American College of Obstetricians and Gynecologists, VBAC is a “safe and appropriate choice for most women” with one prior cesarean and for “some women” with two prior cesareans (1). Being pregnant with twins, going over 40 weeks, having an unknown or low vertical scar, or suspecting a “big baby” should not prevent a woman from planning a VBAC (1).

Research on uterine scar thickness (2) and single vs. dual layer suturing (3) are on-going as the studies completed thus far are not strong enough to provide conclusive support for specific actions.

VBAC is successful 75% of the time (4-8). Successful VBACs have lower maternal complication rates than planned repeat cesareans which have lower rates than VBACs that end in a cesarean (6), otherwise known as cesarean birth after cesarean or CBAC.

Uterine rupture is the major concern in terms of VBAC and while it can be catastrophic, it is rare (9). As the National Institutes of Health asserts, “VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans… The majority of women who have TOL [trial of labor] will have a VBAC, and they and their infants will be healthy. However, there is a minority of women who will suffer serious adverse consequences of both TOL and ERCS” (10).

Permitting labor to begin naturally after one prior low transverse (“bikini cut”) cesarean carries a 0.4% risk of rupture which can increase upon labor augmentation or induction (6). These rates are similar to other serious obstetrical emergencies such as placental abruption, cord prolapse, and shoulder dystocia.

Cesarean risks, including placenta accreta, hysterectomy, blood transfusion, and ICU admission, increase with each surgery (11); whereas after a successful VBAC, the future risk of uterine rupture, uterine dehiscence, and other labor related complications significantly decrease (12).

With each option, the risk of maternal death is very low: ERCD at 13.4 per 100,000 versus 3.8 per 100,000 for TOL (10). The evidence quality on perinatal mortality (infant death within 28 days of birth) is low due to the wide range of rates reported by various studies (11).

45% of American women are interested in the option of VBAC (14), yet 92% have a RCS (15). Some women chose their RCS or it was medically necessary. Others felt like they didn’t have much of a choice for numerous reasons including hospital VBAC bans (16); immense social pressure; or the misrepresentation of VBAC risks (17).

Our repeat cesarean rate feeds America’s rising total cesarean rate, currently at 32% (18). Declercq (2009) links our high cesarean rate with our high maternal mortality rate relative to other developed countries (19).

Throughout America, hospital and doctor attended VBACs are legal (20). In some states, it is legal for a midwife to attend an out-of-hospital VBAC. However, of the women interested in VBAC, 57% are unable to find a supportive care provider or hospital (14). This is due primarily to the 1999 ACOG recommendation that a doctor be “immediately available” to perform a cesarean, yet they provided no clear definition or standard for where the obstetrician and/or anesthesiologist should be or what they could be doing (1).

As a result, hospitals developed their own definitions producing differing VBAC protocols and requirements. The most severe variety was the institution of formal VBAC bans in 28% of all American hospitals and de facto bans in an additional 21% (21), disproportionally affecting women living in rural areas. The 2010 ACOG guidelines addressed these bans and confirmed: “restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will” (1). Hopefully VBAC will become a viable option to the many women who desire it (22).

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Ready to learn more? Check out the list of articles and categories to your left.

Want more information on planning a VBAC? Go here.

Want to help get this basic information about post-cesarean birth options out to the public? The VBAC Facts Micro Brochure are premium 100lb 3.5″ x 2″ matte finish folding business cards that do just that. The front features space for your contact information and the inside contains much of the important facts you just read. Due to their small size, they are convenient to carry and distribute without having bulky pamphlets in your pocket or purse. Learn more and purchase.

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1. American College of Obstetricians and Gynecologists. (2010). ACOG Practice Bulletin No. 115: Vaginal Birth After Previous Cesarean Delivery. Washington DC.

2. Kmom. (2009, February 12). Ultrasound Measurement of Cesarean Scar Thickness. Retrieved from Well Rounded Mama: http://wellroundedmama.blogspot.com/2009/02/ultrasound-measurement-of-cesarean-scar.html

3. Humphries, G. (2004, June 14). The Suture Debate. Retrieved October 1, 2009, from International Cesarean Awareness Network: http://www.ican-online.org/vbac/the-suture-debate

4. Coassolo, K. M., Stamilio, D. M., Pare, E., Peipert, J. F., Stevens, E., Nelson, D., et al. (2005). Safety and Efficacy of Vaginal Birth After Cesarean Attempts at or Beyond 40 Weeks Gestation. Obstetrics & Gynecology, 106, 700-6.

5. Huang, W. H., Nakashima, D. K., Rumney, P. J., Keegan, K. A., & Chan, K. (2002). Interdelivery Interval and the Success of Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology, 99, 41-44.

6. Landon, M. B., Hauth, J. C., & Leveno, K. J. (2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. The New England Journal of Medicine, 351, 2581-2589.

7. Landon, M. B., Spong, C. Y., & Tom, E. (2006). Risk of Uterine Rupture With a Trial of Labor in Women with Multiple and Single Prior Cesarean Delivery. Obstetrics & Gynecology, 108, 12-20.

8. Macones, G. A., Cahill, A., Pare, E., Stamilio, D. M., Ratcliffe, S., Stevens, E., et al. (2005). Obstetric outcomes in women with two prior cesarean deliveries: Is vaginal birth after cesarean delivery a viable option? American Journal of Obstetrics and Gynecology, 192, 1223-9.

9. National Institutes of Health. (2010, June). Final Statement. Retrieved from NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights: http://consensus.nih.gov/2010/vbacstatement.htm

10. Guise, J.-M., Eden, K., Emeis, C., Denman, M., Marshall, N., Fu, R., . . . McDonagh, M. (2010). Vaginal Birth After Cesarean: New Insights. Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK44571/

11. Kamel, J. (2012, Apr 3). Confusing fact: Only 6% of uterine rutpures are catastrophic. Retrieved from VBAC Facts: http://vbacfacts.com/2012/04/03/confusing-fact-only-6-of-uterine-ruptures-are-catastrophic/

12. Silver, R. M., Landon, M. B., Rouse, D. J., & Leveno, K. J. (2006). Maternal Morbidity Associated with Multiple Repeat Cesarean Deliveries. Obstetrics & Gynecology, 107, 1226-32.

13. Mercer, B. M., Gilbert, S., Landon, M. B., & Spong, C. Y. (2008). Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Obstetrics & Gynecology, 11, 285-91.

14. Declercq, E. R., & Sakala, C. (2006). Listening to Mothers II: Reports of the Second National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection. Retrieved from Childbirth Connection: http://www.childbirthconnection.org/article.asp?ck=10068

15. Osterman, M. J., Martin, J. A., Mathews, T. J., & Hamilton, B. E. (2011, July 27). Expanded Data From the New Birth Certificate, 2008. Retrieved from CDC: National Vital Statistics Reports: http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_07.pdf

16. Kamel, J. (2010, July 22). VBAC ban rationale is irrational. Retrieved from VBAC Facts: http://vbacfacts.com/2010/07/22/vbac-ban-rationale-is-irrational/

17. Kamel, J. (n.d.). Scare tactics. Retrieved from VBAC Facts: http://vbacfacts.com/category/vbac/scare-tactics/

18. Menacker, F., & Hamilton, B. E. (2010, March). Recent Trends in Cesarean Delivery in the United States. Retrieved from Center for Disease Control and Prevention: http://www.cdc.gov/nchs/data/databriefs/db35.htm

19. Declercq, E. R. (September, 2009). Birth by the numbers . Retrieved from Orgasmic Birth: http://www.orgasmicbirth.com/birth-by-the-numbers

20. Kamel, J. (2009, February 28). Is VBAC illegal? Is homebirth illegal? Retrieved from VBAC Facts: http://vbacfacts.com/2009/02/28/is-vbac-illegal/

21. International Cesarean Awareness Network. (2009, February 20). New Survey Shows Shrinking Options for Women with Prior Cesarean. Retrieved from ICAN: http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans

22. Kamel, J. (2010, March 9). American women speak about VBAC. Retrieved from VBAC Facts: http://vbacfacts.com/2010/03/09/american-women-speak-about-vbac/

Last revised: 11/11/12

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124 comments to Quick Facts

  • Christina

    I have had 3 prior c-sections:
    #1:9/5/00=induction at 41 weeks. Fully dialated & pushed for 2 hours. Dr opted for c-section. Daughter born at 9lbs9oz.
    #2:6/21/04=induction at 39 weeks. Dialated to 7cm. Dr noted compound presentation. Opted for c-section. Daughter born at 7lbs9oz.
    #3:8/2/08=repeat c-section at 38 weeks. (water broke) Was told no other option but repeat c/s. Daughter born at 7lb4oz.
    We are about to start trying for our 4th baby and I REALLY want a vaginal birth. I was SO close each time! I know that I can dialate. HELP!

  • [...] of the best references for VBAC information that I have found has been this site. Jennifer is AMAZING, a wealth of information, an advocate for all birthing women, a force in [...]

  • Yasmel

    Christina, DO NOT consent to an induction. Your chances of UR increase with induction. Without knowing everything about you case I can say that your inductions most probably failed because your body was not ready to give birth yet.
    Find a Midwife who can support you and give you more info.

  • Doris

    My first was a section and then I had 3 VBACs. Fantastic and no stress!

  • Esha Sani

    Dear Jen – Thank you for all the information on VBAC’s on your website.. It has been very enlightening for me. I was induced the first time at 41 weeks, was told my baby was large and was not advisable to wait any longer. Anyway after 24 hours, I ended up being a C-section. Me & my body did not do anything..everything was done by them….I was given cervix ripening agent..pitocin…epidural (I asked for it…twas very painful..I wish I had pain management techniques and someone to guide me thru those…I learned childbirth class is not enuff..maybe a doula would’ve helped in me having a vaginal birth)…they also broke my water..and finally I was told it would risk baby if we did not do C-section. This was 3 years ago, and I am pregnant again, and would hate to relive that experience. While reading about VBACs, I found I could have avoided my last C-section/induction, and I feel really sad and angry with myself for not keeping myself well-informed. I was in my own rosy world that it’ll be a natural birth and C-section is only the very last option. Me and hubby just went with what the nurses and doc told us at that time.

    Anyway, this time I am determined for VBAC. I am 25 weeks pregnant, and my OB says she will give me a date by which if I do not labor on my own, she will do a C-section. But she cannot give me the date now, only later in last week of December (I’ll be 31 weeks then). I don’t know why we have to wait that long..maybe to find out if I have gestational diabetes or not, but again I am not sure. She is a very sweet & nice doctor..in fact both her kids were C-sections (I don’t think any woman would opt for C-section by choice). So, how can I tell if she is supportive of my VBAC or not? I go to her for 6 years now, and changing docs mid-pregnancy is an uncomfortable thought.

    And on a more general note, since my first was induced which ended in C-section, what are my chances of going into labor on my own without induction. And is it possible to generally predict if will it be beyond 40 weeks or earlier or later ?

    Please help…

    Thanks,
    Esha.

    • Jen from vbacfacts.com

      Esha,

      I’m so sorry it took me so long to reply to your comment. Since it’s the last week in December now, I’m wondering what date your OB gave you. 40 weeks? 41 weeks? I suspect your OB wanted to wait until 31 weeks to give you the “labor or c-section” deadline because the later she waits in your pregnancy, the more likely it is you will stay with her, do what she says, and not switch care providers.

      Here is what I would do: I would switch OBs. My personal opinion is a doctor who puts you on a timeline of give birth by X date or you are having a cesarean is not a VBAC supportive provider.

      You might be surprised to know that many women opt for elective repeat cesareans because they are subtly, or not so subtly, encouraged to do so by their OBs. I would be interested in knowing if your OB scheduled her repeat cesarean without medical indication (suspecting a baby weighting less than 11 lbs or being overdue are not valid medical reasons) or if she truly wanted a VBAC and ended up with a cesarean after labor began.

      Do you think that a woman who schedules an elective repeat cesarean for herself is a supporter of VBACs? Do you think she will truly support your desire to have a VBAC?

      To answer your question, “since my first was induced which ended in C-section, what are my chances of going into labor on my own without induction?” With this provider, I would say your chances are slim to none. With another provider, who is supportive of VBAC and willing to wait for labor as long as you and baby are fine, your chances are much greater. Due dates vary greatly. Some women have longer menstrual cycles, some women just have longer pregnancies. You can learn more here: Figuring your due date.

      You also asked, “And is it possible to generally predict if will it be beyond 40 weeks or earlier or later.” The fact that you were 41 weeks when she induced you means that it’s likely you will go to at least 41 weeks this pregnancy. The difference between your last pregnancy and this one is that you know this time around that she doesn’t support pregnancies going beyond 41 weeks. What do you think in your heart will happen if you stay with this OB?

      I understand that you like your doctor and that she is sweet to you. But please know that liking your OB isn’t enough. You two should be on the same page in terms of your birthing philosophies.

      You said, “I feel really sad and angry with myself for not keeping myself well-informed. I was in my own rosy world that it’ll be a natural birth and C-section is only the very last option. Me and hubby just went with what the nurses and doc told us at that time.” The question is, will you allow that to happen again?

      If you want to look into finding a new provider, please read: Finding a VBAC supportive OB or midwife.

      Please keep me posted!

      Warmly,

      Jen

  • Rowen

    Hello, I hope I am asking this in the right section :)

    I had a c-section on Nov 7, 2008. A little background: I was in labour for 35 hours before getting stuck at 6cm at which point due to my contractions being very irregular my midwife consulted with the Dr on call and opted for oxytocin and an epidural to get me going, from my stand point everything went downhill from here! When it was finally time to push 6 hours after the oxytocin I pushed for 2 hours and my son didnt budge and was seemingly stuck. At this point I was physically and emotionally done and despite wanting a natural birth with no drugs (I counted a total of 11 different drugs by the time everything was said and done) ended up with a very complicated c-section. After the uterus had been closed, they noticed significant bleeding and upon further investigation…

    My operative report says: “…the posterior lower segment of the uterus had buckled forward, giving the appearance of being the anterior portion of the cervix and so the lower anterior portion of the uterus had not been properly sutured to the upper anterior edge of the uterine incision. This was corrected. There were bilateral extensions of the uterine incision. (…) Given the extent of the extension of the uterine incision at surgery, it is recommended that this patient deliver by elective repeat cesarean next time and that she is not a good candidate for VBAC.”

    Basically I am asking if anyone knows anything about this and if I do have a chance at VBAC in the future or not. I haven’t had any luck finding information on this. I am not pregnant now and don’t plan on it for another year.

    Thanks in advance for any information possible

    • Jen from vbacfacts.com

      Rowen,

      I’m not a surgeon or a medical professional, so here is my advice. Get the name of three VBAC supportive practitioners, set up interviews with them, and review your medical records with them. You will then get 3 opinions and will be able to move forward from there.

      I wish you the best!

      Warmly,

      Jen

    • Hi Rowan,
      I am also not a medial professional, but I also had a section, with a similar complication – my incision also extended during the surgery. Regarding the statement in your operative report: “There were bilateral extensions of the uterine incision” this means that they did the incision into your uterus, and then for some reason (perhaps when they pulled the baby out – this is when it occurred for me) the incision extended – meaning that it tore and became larger – bilateral means on both sides – so both sides of your incision tore. So rather than having just an incision, there was an incision and a tear, and because of the degree of the extension, the surgeon recommended that you not VBAC.

      As I said, I also had my incision extend during my section, but my surgeon specified that it would not affect my ability to VBAC, as the extension was only on one side, and was not severe. I just had a VBAC, and when I was pregnant, my OB discussed the extension with me, and explained that it meant that I had a longer scar, that this increased my chance of rupture.

      As Jen said, get opinions from VBAC supportive OBs in order to move forward in your decision making process.

      All the best!
      Avital

  • [...] quickies specifically for the numbers listed above: Baby death rate C-sec Mother dreath rate C-sec Uterine rupture risk baby death Downs Syndrome  risk by age Amnio miscarriage risk Uterine rupture [...]

  • Amy

    Jen – I was hoping you could help. I just want to say first that I’ve been searching the internet endlessly for VBAC information and finally came to your website. You have all the information I have been searching for in one place and with research to back it up. So thanks!!

    But there was one thing I couldn’t find. I have been trying to find out how long you should wait after having a C-section to attempt a VBAC? Does it make a difference from 1 month, 6 months, 1 year, 2 years, etc.? Is there a certain amount of time it takes for your scar to heal?

    Thanks!! -Amy

    • Jen Kamel

      Hi Amy!

      While I cover interbirth intervals in the class, I haven’t had a chance to type it all up in an article. The short answer is: evidence suggests that it’s best to have a 18-24 month interval between your cesarean birth and subsequent births. In other words, wait 9 to 15 months after your cesarean to get pregnant. That said, the studies that have been conducted are rather small, and it will be nice if/when larger studies are conducted so we have a better idea of the risk differential, if any, between births occurring less than 18 months post cesarean versus more than 18 months. I personally think it’s always a good idea to give your body plenty of time to heal and wait at least 9 months to get pregnant. You can read some of the studies available by looking for the terms ‘interbirth’ (time between cesarean birth and subsequent birth) and ‘interpregnacy’ (time between beginning of cesarean pregnancy and the beginning of subsequent pregnancies) by looking through my bibliography.

      Warmly,

      Jen

  • Elizabeth

    Ok, I’m doing a college paper on home births, prosecutions of mid wives and other related topics, and came across your website. Lots of good info on here. However, I have to comment that it might be good, right at the top of the home page, in big letters, to put what VBAC stands for, since I had no idea what the heck it was when I first was looking on here! I finally figured it out, but I just thought it might be a good idea for you to do that. There are likely other people as clueless as I am.
    Thanks,
    Elizabeth

    • Jen from vbacfacts.com

      Elizabeth,

      Thank you so much for this comment. I’ve updated the logo at the top to include the definition of VBAC. I’d love to read your paper when it’s complete!

      Warmly,

      Jen

  • Thanks for linking this up over at The Finer Things in Life. I think this is a wonderful, concise summary of VBAC facts. The only thing that I really wish I would have seen mentioned are the cases where VBAC is not an option. My second child was born at 24 wks via a very fast, very critical classical c-section- a vaginal birth would have been traumatic for a 1 lb 5 oz baby and it was her best chance for survival. (And, happily, she did!) I gave birth to my third baby last year and, trust me, I would have LOVED to have a VBAC rather than a repeat c-section. But the risk is simply TOO HIGH. No doctor worth his salt would attempt it. I got over the disappointment and had the second c-section. What has been the hardest for me? Many women with a very flip attitude that I “could have, should have” attempted the VBAC. While I am thrilled to see more honest, clear information being published to encourage women to consider VBAC, it saddens me that so many of these articles do not really address the small population of women for whom this is not a viable option. As a result, many people assume that we just choose surgery again as an easy way out.. The very first sentence- “If you have had a cesarean, your next baby can be born vaginally safely.”? I’m sorry, but it just isn’t entirely true. Perhaps “If you have had a cesarean, you next baby can probably be born vaginally safely” would work better. I hope this doesn’t come across as argumentative… I am truly happy to see these facts outlined. It is important information! I just know only too well how the generalization that VBAC is an option for everyone can sting.

    • Jen Kamel

      Hi Jessie Leigh!

      Thank you so much for your comment. It’s a little ironic that you made this comment at 4am this morning as I was up till midnight last night rewriting this piece! I just didn’t have it in me to stay up later to finish it, so I put it aside for the night expecting to continue working on it tonight after my kids were asleep!

      So I was saddened to see your comment! I think you will find the new article more fair as I agree, there are women who either desire a vaginal birth, but can’t find a care provider to attend them or, like you, have a medical reason for a repeat cesarean.

      In terms of the comments you have received from others, classical incisions do have higher rates of rupture. Some people aren’t aware of that and others who know of the higher risk, still want a VBAC. But in the end, it is your body, your birth, and your decision and you don’t have to explain yourself to anyone. People can be rude and I’m sorry.

      I have friends who were candidates for VBAC and opted for elective scheduled cesareans. When they asked for information, I gave it to them, and when they scheduled their surgery, I brought them a meal after their baby was born. It’s not my birth.

      I would really love to know what you think of the new article, would you comment again once you read it?

      Warmly,

      Jen

  • Robin

    I have a question for you, please forgive me if it is addressed somewhere else on your amazing website. I was planning a homebirth and things took a very different turn and my son’s heart rate plummeted and stayed down, so my midwife took me to the hospital and his heart hadn’t recovered so the sectioned me. In all the research you have done have you found anything that talks about how long a woman should wait to get pregnant again? I am a bit nervous about giving birth again and in that area your website has been so wonderful. I would like to try for another homebirth and was wondering if you know how long it takes the scar to heal. Thank you for your time.

    • Jen Kamel

      Hi Robin!

      While I cover interbirth intervals in the class, I haven’t had a chance to type it all up in an article. The short answer is: evidence suggests that it’s best to have a 18-24 month interval between your cesarean birth and subsequent births, so it’s probably best to wait 9 to 15 months after your cesarean to get pregnant.

      Stamilio (2007) stated, “We hypothesized that short interpregnancy intervals may lead to altered wound healing and an increased risk of uterine rupture in patients who attempt a vaginal birth after cesarean. Our hypothesis is based on previous observational studies that suggest an association between short birth interval and increased adverse perinatal outcomes and wound-healing research that indicates that uterine smooth muscle tissue repair evolves over several months…. Importantly, there is radiographic and hysteroscopic evidence that cesarean scar development is incomplete as long as 6 or 12 months postoperatively.”

      In other words, your scar is still changing 6 to 12 months after your cesarean.

      Stamilio (2007) found the rate of uterine rupture when women got pregnant less than 6 months after their cesarean to be 3.05%, which was three times higher than the average rate of 0.9%. That is a very high rate of rupture, but keep in mind two things. First, they only had 286 women who got pregnant within 6 months of their cesarean and that is not a large enough population to measure uterine rupture which occurs about 0.4% of the time in spontaneous labors after one prior low transverse cesarean (Landon, 2004). Second, 68% of those 286 women had their labors induced or augmented which we know increases the risk of rupture (Landon, 2004).

      To read the abstract of this study, please go here and you can obtain a free PDF of the entire study here.

      Stamilio (2007) as well as the other studies that have been performed on uterine rupture by interpregnancy/interbirth intervals are rather small, and it will be nice if/when larger studies are conducted so we have a better idea of the risk differential, if any, between births occurring less than 18 months post cesarean versus more than 18 months. I personally think it’s always a good idea to give your body plenty of time to heal and wait at least 9 months to get pregnant.

      You can read some of the studies available by looking for the terms ‘interbirth’ (time between cesarean birth and subsequent birth) and ‘interpregnacy’ (time between beginning of cesarean pregnancy and the beginning of subsequent pregnancies) by looking through my bibliography.

      Warmly,

      Jen

      Stamilio, D. M., DeFranco, E., Pare, E., Odibo, A. O., Peipert, J. F., Allsworth, J. E., et al. (2007). Short Interpregnancy Interval: Risk of Uterine Rupture and Complications of Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology , 110 (5), 1075-1082.

  • Anna

    I had my first cs because of failure to progress. I wasn’t opening up enough and my son had a huge cone head. I believe I did take the epidural too early based on bad advice since I felt I could have labored much longer had I used comfort/ relaxation techniques. I did “love” my ob but when I found out the second was going to be twins he was not positive about a vbac even though the new ACOG information encourages it. His excuse said that he has only done it once and everything has to be “perfect” in order to do it.

    I began looking for new ob’s and contacted a few. I got one response and she said even in her hospital setting that allowed VBAC’s she refused to do it with twins. I then asked a nurse who works at the hospital and she told me to ask another ob which I did. I got a fast response from him that stated that he saw it as no different than a singleton VBAC. The only thing he wouldn’t do with me is if both were breech since I have never sucesssfully delivered vaginally before. He wouldn’t want the head to get stuck. So as long as baby A is head down the second can be breech. He discussed all the risks and put me down for a VBAC registered with the hospital. It is true that it is always better to get second and third opinions about your situation and find the right doctor for you even if you don’t “love” them or their personality. They are supposed to do a good job not be your best friend.

  • tosin

    Hi, I had a baby 22months ago thru cs and I’m 40wks pregnant now. I’m still hoping 2 go into labour. Is there a possibility of a VBAC

  • Jennifer

    Do the risks of a VBAC increase if you got pregnant right away after the c-section?

    • Jen Kamel

      Hi Jennifer!

      While I cover interbirth intervals in the class, I haven’t had a chance to type it all up in an article. The short answer is: evidence suggests that it’s best to have a 18-24 month interval between your cesarean birth and subsequent births, so it’s probably best to wait 9 to 15 months after your cesarean to get pregnant.

      Stamilio (2007) stated, “We hypothesized that short interpregnancy intervals may lead to altered wound healing and an increased risk of uterine rupture in patients who attempt a vaginal birth after cesarean. Our hypothesis is based on previous observational studies that suggest an association between short birth interval and increased adverse perinatal outcomes and wound-healing research that indicates that uterine smooth muscle tissue repair evolves over several months…. Importantly, there is radiographic and hysteroscopic evidence that cesarean scar development is incomplete as long as 6 or 12 months postoperatively.”

      In other words, your scar is still changing 6 to 12 months after your cesarean.

      Stamilio (2007) found the rate of uterine rupture when women got pregnant less than 6 months after their cesarean to be 3.05%, which was three times higher than the average rate of 0.9%. That is a very high rate of rupture, but keep in mind two things. First, they only had 286 women who got pregnant within 6 months of their cesarean and that is not a large enough population to measure uterine rupture which occurs about 0.4% of the time in spontaneous labors after one prior low transverse cesarean (Landon, 2004). Second, 68% of those 286 women had their labors induced or augmented which we know increases the risk of rupture (Landon, 2004).

      To read the abstract of this study, please go here and you can obtain a free PDF of the entire study here.

      Stamilio (2007) as well as the other studies that have been performed on uterine rupture by interpregnancy/interbirth intervals are rather small, and it will be nice if/when larger studies are conducted so we have a better idea of the risk differential, if any, between births occurring less than 18 months post cesarean versus more than 18 months. I personally think it’s always a good idea to give your body plenty of time to heal and wait at least 9 months to get pregnant.

      You can read some of the studies available by looking for the terms ‘interbirth’ (time between cesarean birth and subsequent birth) and ‘interpregnacy’ (time between beginning of cesarean pregnancy and the beginning of subsequent pregnancies) by looking through my bibliography.

      Warmly,

      Jen

      Stamilio, D. M., DeFranco, E., Pare, E., Odibo, A. O., Peipert, J. F., Allsworth, J. E., et al. (2007). Short Interpregnancy Interval: Risk of Uterine Rupture and Complications of Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology , 110 (5), 1075-1082.

  • ami

    OK I have a question I am pregnant with my fourth baby im 5 weeks, I have had 3 c-sections. My first baby was 2 days late and i whent in so the dr could induce me and i went in to laber on my own by walking while I waited for his plane to land and him to get to the hospital( he was on vacation but was on his way home anyways) well I dilated to a 5 just fine and the pain was not bad but he said my epidural was there so he started the epidural and thin thay said my contractions were to slow so thay gave me pitocin and he said she was beating her haed agains my hips and we needed to get her out so thay cut me open. with my second baby he said i could vbac but i was scaerd and opted out. so with my therd baby the obgyn i had for the first two was moven and left his practice to a nother obgyn. this obgyn is the one that deliverd my last baby on sep 9 2009 he told me no on a vbac and told me after my c-section that he had a hard time getting through the scar tissue and he had a time sewing me up. so Iguess im asking do u think he might be willing to try a vbac seeing how he dont like the idea of cutting me open?

    • Jen Kamel

      Ami,

      The only way to know if your OB would be willing to attend your VBA3C is to ask him. Yes, each surgery results in more scar tissue which can make the surgeries more complicated and longer and the risk of complications increase with each surgery. The Silver 2006 study for more specifics on the risks of multiple surgeries which you can read about here.

      On the other hand, we do not fully understand the risks that accompany a VBA3C because the studies that have been performed are to small. Go here for more information.

      Warmly,

      Jen

  • Pamela

    Hi Jen , I have a big question for you . I had 3 c/s , 1 necessary , another one after failed induction , then 2 normal , unproblematic deliveries and then another c/s , after the doctor broke my water without asking me first , because he felt , “we should get things going” .
    Now my question . I am pregnant again and I will do anything in my power to avoid another cesarean , but what are my chances to deliver about 18 months after the last c/s ?
    And also , I read somewhere , that every normal delivery decreases the risk of a uterine rupture . What about my case , did I “lose” that after the last c/s or not ? Please help

    • Jen Kamel

      Pamela,

      The information on VBAC success and uterine rupture rates by birth interval are still weak because the studies have been small. Hopefully we will have larger studies in the future so we can get a better idea of the success rates and risks. What we know now is briefly summarized here.

      Mercer (2008) concluded that after one VBAC, future success rates increased while uterine rupture and labor related complications decreased. Specifically, they found the uterine rupture rates in a spontaneous labor with no prior VBACs to be 0.87%. This dropped to 0.45% after one prior VBAC. However, is this protection diminished after having another cesarean? I haven’t read anything that talks about how the risk changes in the vaginal birth -> cesarean -> VBAC -> cesarean scenario. Sorry I can’t be more help.

      Warmly,

      Jen

  • Brandy

    Hi,
    I had a c-section with my daughter. I was 41weeks so my Dr. induced. After 4 centimeters I got an epidural. The Dr. had to break my water, but I was progressing very slowly.I stopped dilating at 6 centimeters. My heart rate was dropping in between contractions and I had already been in labor for 34 hours. So he gave me a c-section. I was wondering if my weight gain could have contributed to my lack of going in to labor. I gained 60 pounds with my daughter. I am pregnant now with a boy, 30 weeks now and have only gained 15 pounds so far. I am wondering if there is anything that I can do as as far as exercise or diet or anything to help me go in to labor instead of being induced. I am scared to get induced again because my body obviously was not ready. Please help

  • Rebecca

    My first pregnancy resulted in a c-section due, I believe, to an over anxious young dr. I could write a detailed explanation as to why I believe the ineptitude of my dr lead to an un-necessary surgery. Instead I’ll just say that I was told that I needed a c-section because of fetal distress but the notes and chart indicate that the only reason I was scheduled for a c-sections was “failure to progress.” My baby is currently 7 months old and I am about two months pregnant. My ob, the delivering dr but not the young one, has said that he sees no problem with a vbac attempt because the studies about time between births is inconclusive. I’m a bit worried but realy don’t want a repeat c-section. Should I be? Thanks

  • Amina

    Thank you verry much for all the information really is helpfull,my question is, is there any thing I can do to increase a chance of a VBAC, I am now 31 weeks thank you

  • Sarah M.

    Hi, I am so pleased to hear the risks for VBACs are so low. Do you by any chance know what the risk is after having 2 c-sections and then trying to have a VBAC? I talked to my doctor and she does not like the idea, but she will not be my doctor when I have the baby because I will be moving out of state. Also, my scar is horizontal in the bikini area and from what I know there were no complications. However, ever so often if I get up too fast I can feel a sharp pain coming from where my scar is. Is this normal and should I rethink my choice to have a VBAC because of this mysterious pain?

    • Jen Kamel

      Hi Sarah!

      The Landon 2006 study found that the risk of uterine rupture after two prior cesareans was 0.9%. The latest ACOG recommendations support VBA2C (vaginal birth after two cesareans) in “some women.” Plussizepregnancy has a great overview of the VBA2C research which you can read here.

      I recommend you get a copy of your medical records and surgical reports for each cesarean and review them with one or two VBAC supportive providers. Then you can make an education decision.

      Sometimes women who are pregnant after a cesarean have adhesions (internal scar tissue) and as your uterus grows and things move around, some of this scar tissue can break up. This might be what you are feeling, but I would recommend talking with your care provider if it concerns you as I am not a medical professional.

      Warmly,

      Jen

      Landon, M. B., Spong, C. Y., & Tom, E. (2006). Risk of Uterine Rupture With a Trial of Labor in Women with Multiple and Single Prior Cesarean Delivery. Obstetrics & Gynecology , 108, 12-20.

  • Amy

    Dear Jen,
    I hope you still come around here from time to time! I have a question, too. I was just informed by my midwife that my “emergency” cesarean 16 months ago was not as concise as the doctors and hospital led me to believe; that there is a vertical tear (extension) midway through my horizontal incision. I am angry and upset for more than one reason, but that’s not why I’m here. I was planning a HBAC, and now I’m afraid I’ll have to go to back to the incompetant hospital that butchered me unececssarily in the first place. I have an appointment for ultrasound in 2 days and I will ask the homebirth-friendly doctor what he thinks. I’m just terrified I’ll never be able to have a natural birth again. What do you know about this? Is it cause to worry? What are the chances of successful VBAC or HBAC? I really don’t want to go to a hospital because I feel like my body won’t be given the chance to deliver naturally. I’m 23 weeks along now, if that makes any difference… To make matters worse, my husband is already fearful of HBAC. :(

    Thanks in advance,
    Amy

    • Jen Kamel

      Amy,

      I’m so sorry you learned about this during your pregnancy. It’s one thing to know before you get pregnant, so you can make a plan, and an entirely other thing to get pregnant, make a plan, and then have everything go askew.

      I have not read any studies that talk about the implications for a vertical extension along a horizontal incision. I would suspect that this would increase your risk of rupture with the length of the incision affecting the increased risk of rupture. Talk to the HB friendly doctor and see what they advise. I personally would probably deliver in a hospital with this HB friendly OB just in case.

      I’m so sorry. I hope the OB you are meeting with has better information for you.

      Jen

  • Natalie

    Great site. Long story as short as possible. Had a cesarian March, 1999. I had been induced at 40 weeks, had severe toxemia and took the epidural too soon. Many things could have been done different/better. Anyhow, had a successful VBAC with an 11 pounder in October of 2007. Currently 40 weeks and I am telling you, trying to find the support to do an additional VBAC has been utterly ridiculous. It has been over 11 years since my one and only cesarian, I had a successful VBAC with NO complications with a very large baby, what is the problem here? It has been so frustrating. I don’t want to change providers, and in all honesty, it was hard enough getting this one on board. He says he is, but every time I come in he asks me if I’m still sure it’s the route I want to take. I feel subtly pressured, but I’m holding my ground. The office got me worried because my doctor was going out of town and they basically told me that if I went into labor while he was gone I would more than likely end up having a cesarian because it would be dependent on the doctor’s opinion who happened to be on call in that hospital. So, here lies the question: can they FORCE you to have a cesarian if labor is progressing normally? Can I determine to labor naturally anyway against medical advice should they try and tell me I have to without medical a reason? Now, don’t get me wrong, if something bad happens, I want these doctor’s on my side and I will do whatever I need to protect the health of myself and my baby, but with so much time having passed and one successful VBAC under my belt, I feel my chances are so slim and I just want these darned doctors on my side!
    Thanks for all your info, and for letting me vent a little and ask my question. I will do an update (hopefully soon) with how it all went down.

    • Jen Kamel

      Natalie,

      They don’t need to force you. If a doctor doesn’t support VBAC, they can simply tell you that you and/or your baby are in danger. The question is, how can you tell the difference between you/your baby being in real danger vs. the OB fibbing to “do the cesarean already.” Here are three examples of women who had unsupportive providers: Scare Tactics vs. Informed Consent, VBACing Against the Odds, and Another VBAC Consult Misinforms.

      However, there have been cases of women being forced to undergo a cesarean as they yelled, “I do not consent!” Check out this article from the National Advocates for Pregnant Women entitled, Could you be forced to have a cesarean? There was a really frightening presentation given at the 2009 ICAN Conference on this very topic.

      I understand not wanting to go through finding another provider. There may or may not be another care provider in your area who is more supportive than your current OB. No one can predict what will happen when you go into labor. It seems to me that your OB isn’t really on board, his/her partners aren’t really on board and that diminishes your chances of having a successful VBAC with them. Sometimes OBs who are somewhat supportive require a textbook labor otherwise, they pull the plug.

      I don’t think there is anything you can do to get them on your side. Some women in your situation opt to hire a montrice who will come to their home once labor begins. Montrices are trained to listen to heart tones and perform cervical checks so you can transfer when you are in an established labor and don’t arrive at the hospital to early. Other women don’t feel safe laboring at home.

      Please let me know what happens with your labor!

      Warmly,

      Jen

  • Athena

    Recently, a doctor in my area refused to treat me any further because I told him I was not open to the idea of a second cesarean. I have been told this kind of blatant and sudden termination of patient care is not only illegal but unethical. I am currently 40 weeks and 5 days pregnant and terrified to go to any hospital in the area – they are all owned by the same corporation this doctor worked for and they all state they have “VBAC Bans” in place, despite the idea of banning vaginal birth after cesarean is illegal (with regards to my internationally and federally protected rights to informed consent and refusal of medical treatment.)
    Who do I contact about my doctor abandoning me as a patient? Who do I contact about the “health system” corporation in my area violating patient rights? Lawyers in the area will not help me because for them, they only take a malpractice case after someone has been hurt or died. I’m not looking for an ambulance chaser, but someone to help me ensure no other woman is frightened or forced into unnecessary major uterine surgery because she doesn’t know her rights.
    I’m supposed to be able to trust my OB/GYN and have no been able to find help anywhere. After reviewing ACOG’s highly respected articles I feel like my doctor doesn’t have my best interest at heart and is not concerned with the health of my baby. This man didn’t even take the time to review my past medical history before assuming my second child was “too big” to fit through my birth canal (something incredibly rare and over-used in today’s doctor’s offices.) This man should not be allowed to treat women and tell them lies – I can think of no other reason for him to be doing this other than to charge insurance companies more money and make more of it because a cesarean is more “efficient” for the doctor’s time. He is a danger to the health of our community and so is the company he is working for.
    Please, help me. Let me know who I can go to. I’m at a loss here, I’ve been searching for two months for help and every place I turn I’m told “the hospital has a ban on VBAC” or “Florida statue doesn’t allow me to treat you in a birthing center.”

    Thank you for your time and understanding,
    Athena

  • Laurie

    Hey Athena,

    I’m so sorry that you’re dealing with this. I’m not sure what part of Florida you’re in, but in Orlando we see this happen (far too) often. I’m involved with our local ICAN chapter and I’m hoping we can help you. There is a ban on primary vbacs in birth centers in Florida, but not homebirths. And even if a hospital has a ban in place, there are still some possible ways around it. Join our ICAN group and let’s talk! http://health.groups.yahoo.com/group/ICANofOrlando/

  • Meredith K.

    First of all, you can present in labor at any hospital and they must treat you. The Emergency Medical Treatment and Active Labor Act (EMTALA) is a U.S. Act of Congress passed in 1986 that ensures your right to emergency medical care. A “VBAC Ban” cannot be enforced when you are in active labor, it only means that you cannot PLAN a trial of labor there. Now, that doesn’t mean it will be warm and fuzzy and they’ll be happy about it, but I doubt very much they will force a c-section against your will unless they can document a medical emergency, just as in any other trial of labor, otherwise they know they will be sued. Read everything and sign as little as possible, or simply defer most of the paperwork until the baby is born. They cannot do anything if you refuse to consent, and they cannot refuse to treat you if you are in active labor. When you present, just say you don’t have an OB. The on-call OB will have to deliver you.

    Secondly, complaints of patient abandonment should be lodged with the Medical Board of Florida. State laws say that a Dr can give you 30 days notice to legally terminate care (if she/he isn’t transferring care to another practitioner). I have no idea if you have a valid abandonment cause, as I am not qualified to give legal (or medical) advice, but if you want to file a complaint, that’s where to look.

    Best wishes for an uneventful birth!
    Mere

  • Athena

    Thank you all, I will contact ICAN and NAPW. I am in Lee County, FL by the way.
    The worst part of this whole thing started with a midwife I can no longer trust. She was my primary care provider for my first and second child. My oldest was induced way too early unnecessarily (I was 19 years old at the time and in no condition or state of mind to have made that medical decision on my own, that they left it to me shows how irresponsible the hospital is.) I had to be treated by the midwife’s husband (an OB) and he “delivered” my daughter. With my son I managed to go full term, my water broke, and in three days my midwife was telling me I had to go to the hospital because my labor wasn’t progressing. Once there I was again induced, but this time the whole thing went wrong. They gave me too much or something happened that the contractions were not managable (my daughter’s birth was nearly painless) to the point of me being unable to breathe. I was 10cm 100% eff and my son’s forehead was being smashed against my cervix. I don’t know how they could have missed this, but my midwife told me if I wanted to give birth and not pass out from pain and be forced to have a c-section I would HAVE to get an epidural. (Again, I’m not competent at this point because I’m exhausted, in a lot of pain, and terrified.) I tell them “okay” because I just want my baby out and safe. I get the catheter, the epidural, and a lot of really embarrassing and degrading emotions flood through me because I’m don’t feel like I’m “right” after failing to give birth naturally twice in a row. After whatever extended period of time, the midwife returns this time telling me I’ll have to have a cesarean or my baby could die. After a lot of tears, a terrified Daddy, and and exhausted Mommy, the last thing I wanted was for something awful to happen to my son. I agree to major surgery and crying almost the entire time. I fail to breastfeed my son properly (so again, I feel like a failure because I’m not “woman” enough to make sure my children can survive.) I have severe detachment issues with my son until he’s about 3 months old, but until the day we stopped giving him formula, a wave of failure, sorrow, and gut-twisting depression hit me every time I fed him.

    Tell me this: is it ethical for a midwife to have her husband as her back up OB? Are they going to make the best decision for their patient, or will one of them cave to the other because they’re married?

    When I found out I was pregnant with my second son I was elated. I cried a little because we didn’t really have money set aside for another baby and I didn’t think we were ready. When I went to this same midwife a to confirm the pregnancy she told me I had two options: my second cesarean OR I could “terminate the pregnancy” (i.e. murder my child.) She immediately referred me to her husband’s office.

    I never went. And I never saw her again.

    I started seeing a care provider in July after a trip to the emergency room with severe abdominal pain and being guilt tripped by EVERY medical professional I came into contact with. So I went to a practice that had midwives and I told them I only wanted to see midwives, no doctors. They told me I would be required to have a consult with an OB because I’ve had a prior c-section. I wasn’t happy about this, but I agreed after my midwife told me “just tell him why you don’t want a c-section!”

    Well I told him. And now I’m 40 weeks 6 days into my pregnancy. I’m scared that I won’t be able to go into labor on my own (because my last two pregnancies were intervened, will my body even know what to do?!) I’m scared that my baby will be too big (the ultrasound tech estimated he’d be 10 pounds if he was born on time, my daughter was only 6 pounds 5 ounces!) I’m scared to stay home and give birth here, but I’m more terrified of going to the hospital and never coming back.

    It’s about more than just me. It’s about the other two children I made the commitment to bring into this world and love and be there for them. How could I possibly, flippantly, go in for ELECTIVE major surgery that could kill me and my baby?

    One of the biggest things I’m struggling with right now is being “overdue.” I know the baby will come when he’s ready, but I really did expect him to be early. I expected he would be here 3 weeks ago. Now I’m struggling to remind myself that reliable midwives don’t consider a baby overdue until 42 weeks, 1 day. I’m struggling to convince myself my baby is not too big for me (I have a pretty big birth canal and my hips are quite wide…) I’m praying that nothing bad will happen to my baby because I’m giving birth at home. I feel like there’s not happy medium here because I have misgivings about the hospital and my home.

    No one I’ve spoken to with the exception for my children’s godmother is supportive of what I’m going to be doing. She’s fine with however I give birth as long as me and the baby are safe. Everyone else thinks I’m insane for avoiding the hospital. My boyfriend is chewing his hands off with fear because he doesn’t want anything to happen to me. My family and work colleagues aren’t supportive either. It’s come to the point that I don’t plan on calling ANYONE once I go into labor.

    I’m not a stupid person. I’m motivated (working full time, going to college full time, taking care of my kids, being pregnant, and trying to by a house all at once) and I’m on my last semester before my AA degree, so I wish people would stop treating my like I recently grew a tumor and am refusing to have it removed because it’s “special…”

    I just want to know that my rights and wishes will be respected, to know that someone has confidence in me, and that my baby will arrive healthy and when he’s ready.

    How do I know if the placenta isn’t shrinking? How do I know there’s enough fluid? How do I know I don’t actually NEED to go to the hospital? What if I go and they tie me to a bed, drug me, and cut me open against my will? I won’t even be able to scream…

    Giving birth shouldn’t be this scary.

  • Jessica

    Hello, I have a question that I have not seen answered yet. I am currently 30 weeks pregnant with our second child. With my daughter (July 2010) I went over 41 weeks but my water broke naturally and labor progressed well. However, I pushed for four hours and my daughter did not come, so they did an emergency c-section when her heart rate started dropping during contractions. When they got in there to get her they realized she was all wrapped up in the cord, it was around one of her shoulders and twice around each foot. I was very disappointed that I could not deliver her naturally, but the fact she was wrapped in the cord gave me hope for a future VBAC. During this pregnancy they have found I have the antibody E and the baby has antigen E, so we have to go for weekly ultrasounds to make sure everything is alright with her blood. Last week the specialist told me I would need to have her two weeks early because the ultrsound becomes less affective in determining if her blood is being negatively affected by mine. When I talked with my midwife last week she said there is not a doctor in the clinic who would induce me after having a prior c-setion. I truly do not want to be induced because I know inductions are more likely to end in c-section anyway. The clinic I go to has three midwives and I love each of them, however the one who was with me during the pushing of my daughter has also said she thinks my bone structure is very small and may not even be conducive to a vaginal delivery. I guess I just feel like I have a lot of odds stacking against me, but my husband and I want a large family and I just feel like having a RCS will limit the number of children we can have. If you have any advice or suggestions I would be very grateful.

    Thank you, Jessica

    • Jen Kamel

      Hi Jessica!

      I am not qualified to give medical advice, so I’m opening your comment to the Facebook community where I am friends with medical professionals. Hopefully someone there will be able to answer your question. I’ll ask people to post their replies here so future readers can easily find the information.

      Warmly,

      Jen

    • Jen Kamel

      Jessica,

      I haven’t received many responses to your question when I posted it on Facebook, but one person said, “I would think her doctors would probably be best to advise on this: if her issue is similar to the rh sensitization thing (where your body will attack the baby) it’s a huge deal.”

      Like I said before, I’m not qualified to give medical advice and I wish I knew more about this specific topic to direct you to some additional resources. You might get more responses if you post your question on ICAN’s facebook page or the Unnecesarean’s facebook page.

      Sorry I can’t be more help,

      Jen

  • KG

    Hi Jen;

    I have read your replies about going over 40 weeks is not reason for RCS. However, now the midwives (my doc is out of town) are telling me that the NST shows I should have a RCS tonight even though baby’s biophysical profile is 8/8. Do I consent? I will be devastated if I can’t even have a TOL. I am hardly dialated to a one and 50 effaced. I have had pregnancy massage, acupuncture, and all the sex I can handle at 40 weeks, 5 days. I need labor to start!!!

    • Jen Kamel

      Hi KG,

      I’m not qualified to give medical advice, but I posted your question on Facebook where I am friends with many medical professionals who might be able to give you some ideas.

      Warmly,

      Jen

  • April

    Thank you for all the info!
    I do have a question…

    My son, 15 months old, was born via c/s. I was attemping a home birth and transferred to the hospital because I felt like something was wrong. Turns out I had a distended bladder. Once that was releived everything was okay. Almost painless! But it had already been about 38 hours of labor at that time. I did get to 10 cm and pushing stage, but baby was not coming fast enough after 4 hours of pushing and I was EXTREAMLY tired after 44 hours of labor then. We opted for c/s. Had I been in my right mind, I would have got on my knees and pushed the kid out. Until the c/s, I had no pain meds, not induction and the c/s was not an emergency. During surgery I hemorraged.

    Later the OB told me that my uterus was “thin”. And that is was hard to repair me.

    I did get the medical report, but it wasn’t very detailed and I can’t read half the stuff anyway.

    My question is this: does a “thin” uterus mean that it would be a bad idea for a VBAC next birth?

    I’m not pregnant yet, and we don’t intend to get pregnant for some time yet, but I like to be well informed in advance.

    I feel that had my labor not been so long, I would have been able to get him out, but because I was so exhausted, I didn’t have the energy to continue.

    Thanks

  • Kelly

    Thank you for the wonderful site.
    My story: 2007-my first pregnancy was induced, labored for about 8 hours, pushed 30 minutes, small tear. I was so relieved, great experience overall. 2010- from first sonogram at 18 wks, baby was breeched, and stayed that way. Tried exercises, chiropractor, he wouldn’t budge. Very upset for csec at 39 weeks. Very tough recovery. Now with #3 due in April (I’m 24 wks), I had assumed I’d have a vbac, but both my doctors,one old, one young both have said, it’s my choice, but if it were their wife/daughter, they’d do the csec. Do you think they say that because the payout from insurance is so much higher? I absolutely dread the surgery, but they have my husband scared into wanting the csec.
    Not sure if this helps, but my mom had 5 kids, her 1st a csec after laboring for 35+ hours and not fully dialating, then 4 natural vbacs. I just want someone to make this choice for me!

    • Jen Kamel

      Kelly,

      It sounds like your OBs are not supportive of VBAC and that it is quite likely you will have another cesarean if you stay under their care. The question is, are you ok with that? If not, it’s time to get a new care provider.

      Your OBs might not be supportive of VBAC because it’s easier and faster for them to perform a cesarean than wait for you to labor. Performing repeat cesareans provides them more protecting legally because it anything goes wrong, they have already done the most they could do: perform a cesarean. They might also be under pressure for their hospital administrators or other OBs in their practice. They might have also recently experienced an uterine rupture or a lawsuit and that can also make OBs less likely to want to attend a VBAC. There are many, many variables at play. But none of these variables have to do with you, your baby, and your health.

      The fact that you have already had a vaginal birth increases your chance of VBAC success to over 80% (Landon, 2005).

      No one can make this decision for you, but many women find it helpful to look into the risks and benefits of VBAC vs. repeat cesarean. This article might be a good one for you and your husband to read together: .

      Warmly,

      Jen

  • MG

    Hi Jen,
    My first deleivery was c-section 6 years back and I’m pregnant with my second. I have mild cystocele after my first owing to the fact that I was in labor for abt 15 hours or so and had c-section becuse I didn’t dilate enough. My question is, is it okay to go for VBAC with cystocele or should I opt for C-section? Will my prolapse worsen with VBAC? I am really worried about my worsening my prolapse bacause i ended up with cystocele even without having a vaginal birth in the first case and it looks like having VBAC might have a higher chance of worsening the prolapse.

  • Laura B

    Hello! I have learned a lot with ur article!
    Quick back story, i had my first boy may 2009, even though
    Was slow progressing, the dr. Said he believed i could deliver vaginally and finally after 38 hrs later i had him vaginally. I do believe ir was slow becuse i got induced only becase those days he was on call at the hospital i was 40w 2D.
    Second baby was born 8 months ago on april 2011 they believe ( i say this cuz i know i wasnt that into the pregnancy) i was 41 weeks ( in my calculations i was about 38 weeks) they induced me twice and then after an ultrasound noticed baby was breech, he was turning by the hour. Had a csection i felt i was robbed wierd feeling but thats how i felt i wanted to deliver vaginally. My midwife convinced me it wa the best and at that point i was tîred and agreed.
    Now 8 months later im 8 weeks pregnant with third and even before seeing my midwife she sent me a msg through her secretary letting me know that shes happy to treat me but to keep in mind it was goig to be a repeat csection. They have this rule of no attempted vbac before 18 months.
    I do understand the risks because i got pregnant only 6 months post csection
    But at this point i feel
    Frustrated i feel like they shut me down before ven looking at my case Independently, ive been looking for another provider so far all
    Doors have closed on me ven my own midwife. I just want to be given the chance.
    Now going to take Care of 3 little kids and ppl seem
    To forget that a csection is a major surgery and even though i had no issues with my csection the healing is way longer and i couldnt pick up with older kid is just too much.
    I know ican deliver vaginally and i eant to do it.
    How cAn i convince my midwife?
    Pls help!!
    Thank youu!!

  • amber

    i am pregnant for the second time my first child was diliverd by c-section my goal is to have my second child natural but the obgyns in my area will not allow someone who has had a c-section to have a natural birth they said it is hospital policy what would you recomend

  • Sarah S

    Hello Jen,

    I have been researching for a while to find out information on my specific situation, and a midwife pointed me towards your website.

    I delivered my 1st child preterm via emergency c-section with an inverted-T incision at 34wks (5 1/2 yrs ago (10/2006) I started contracting, nothing would stop the contractions and baby was very breech). My second child was delivered via a repeat c-section (not T, it was just one horizontal cut) at 37weeks because of fears of uterine rupture (i was also given weekly progesterone shots starting at 14weeks to prevent preterm contractions) (Aug/2010). I am now pregnant with my 3rd child (surprise pregnancy :), conceived 11/2011, due date 9/1/2012) and I am wondering if a VBAC is even an option for me. I talked to a midwife and she said that in the state of CA that they are not allowed to attempt a VBAC for someone in my situation. I have my first prenatal visit scheduled in 2 days, and would like to have more statistics/facts in hand before I attempt discussing this with my OB.

    Thank you for all your help.

    Sarah

    • Jen Kamel

      Sarah,

      The evidence we have on classical, T and J incisions are of low quality. The few studies that have been completed group classical, T and J incisions together and include extremely few women – 130 or less. Spong 2007 quoted a 1.59% rate for classical, T and J incisions, but there were less than 50 women included. Landon 2004 quoted 1.9% for classical, T and J incision, but again, there were about 130 women. ACOG quotes a 4-9% rupture rate. You can review ACOG bibliography of the 2010 guidelines to see if they cite any additional studies. Bottom line: we don’t have a good idea of what the rupture rate is in classical, T and J incisions. The conventional wisdom states, if the incision goes into the fundus (the upper part of the uterus), the rate of rupture is substantially higher. Until we have better, larger studies, that’s the best info we have.

      Thus, ACOG states that women with classical, T or J incisions are not “generally” considered candidates for VBAC. Per the latest (2010) ACOG VBAC recommendations: “The preponderance of evidence suggests that most women with one previous cesarean delivery with a low transverse incision are candidates for and should be counseled about VBAC and offered TOLAC. Conversely, those at high risk for complications (eg, those with previous classical or T-incision, prior uterine rupture, or extensive transfundal uterine surgery) and those in whom vaginal delivery is otherwise contraindicated are not generally candidates for planned TOLAC.” They do leave the option open by using the word “generally.” Read a summary on ACOG’s VBAC recommendations here: http://vbacfacts.com/2010/07/21/acog-issues-less-restrictive-vbac-guidelines/. Read the actual ACOG recommendations here: http://www.ourbodiesourblog.org/wp-content/uploads/2010/07/ACOG_guidelines_vbac_2010.pdf.

      Warmly,

      Jen

  • Tiarra

    In 2006 I gave birth via c-section @ 34 weeks to a 4lb 9 oz baby girl, she came early because of my HUSBAND he just couldn’t get enough of me. I had no problems with my labor at all…..In Oct 2011 I gave birth to another baby girl via c-section she was 7 lbs 11oz @ 39 weeks because I was miserable (I was huge, my feet always hurt, and my hips ached…etc) and on top of that my doctor told me that I should have one…..Now I feel bad because me and my husband want another baby within the next year or so and I really want a vba2c and I’ve been told I can’t have one….Someone please let me know if I can give birth naturally after 2 c-sections? And if so, please send me the names of doctors willing to do a vba2c…..

  • Clare

    hi Jen,

    I am due 20months from my first csection. It was emergency because I had pre-eclampsia. My bp has been good so far (21weeks), we are considering VBAC but I heard some1 say the chances of a still-born are higher because I had one with the first pregnancy

  • whitney

    Hey I had my daughter In Jan of 2011 And my next baby is due in June I was in labor for 38 hours and pushed for two hours. Just to have to go in for an emergency section.l haven’t given myself nine months It was only eight months. And I’m scared to have a vbac . All tho my doctor says its ok. I just feel like I haven’t given myself enough time. And if I do rapture. Are the chances of survival still good. Because I also tore and have the longer scar.please help me I have 3months left. Before my duedate.thank you so much all tho I have God on my Side. I feel like I need to decide. Too.
    If anyone could help that would be awesome:)

    • Jen Kamel

      Whitney,

      Fortunately, every birth is different so you are not doomed to another long labor that ends with a cesarean. This is a decision only you can make.

      A recent review of 400 VBAC studies prepared for the 2010 National Institutes of Health VBAC Conference reported the risk of maternal death: 1 in 26,316 (0.0038%) VBAC vs. 1 in 7,463 (0.0134%) RCS as well as the risk of infant death: 1 in 769 (0.13%) VBAC vs. 1 in 2000 (0.05%) RCS (Guise, 2010).

      You can read the entire study here.

      You might also enjoy reading this article: “Nervous about planning a VBAC” or this article where a dad asked, “Why invite the risk of VBAC?”

      Best of luck with your decision. As you learn more and more about your post-cesarean birth options, you will see that neither is inherently risky or safe, but each offer their own set of risk and benefits. Fortunately, the risk of dire complications is low.

      Warmly,

      Jen

  • whitney

    Thanks I just seen that you said you should give yourself at least 9 to 18 months to get pregnant again and I didn’tI only gave myself 8 months. Thats what I was worried about.

    • Jen Kamel

      Whitney,

      All the studies I’m familiar with on birth intervals and uterine rupture are smaller studies. My personal lay opinion is that the difference in the rupture risk between getting pregnant 8 months post-partum versus 9 months post-partum is minimal. It’s not as if your risk up to 8 months and 30 days post-partum is really high and then it drops really low at 9 months 1 day post-partum.

      Your doctor is comfortable with your birth interval. I would trust that.

      As Guise (2010) says,

      VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans… The occurrence of maternal and infant mortality for women with prior cesarean is not significantly elevated when compared with national rates overall of mortality in childbirth. The majority of women who have TOL will have a VBAC, and they and their infants will be healthy. However, there is a minority of women who will suffer serious adverse consequences of both TOL and ERCD. While TOL rates have decreased over the last decade, VBAC rates and adverse outcomes have not changed suggesting that the reduction is not reflecting improved patient selection.

      You need to chose the mode of delivery that you feel best about. Some women have repeat cesareans and are happy with that decision. Read more about the risks of cesareans including how the risks of cesareans increase with each surgery.

      Both VBAC and repeat cesarean have risks and benefits. Read more about the risks and benefits of each option and, together with your care provider, decide which set of risks is more acceptable to you.

      Warmly,

      Jen

  • Jen B

    Hi Jen,

    You must get frustrated answering the same questions a million times over. Thank you for providing such a detailed and informative website. Maybe people (myself included) just like hearing a voice on their own individual situation. So, sorry to repeat :)

    My details: I am in my 4th pregnancy. First, 12 years ago, uncomplicated, induced, fast delivery, baby adopted out. Second, 2.5 years ago, AMAZING, fast baby basically pushed himself out, no intervention, nurses delivered. 3rd, 1 year ago, baby turned transverse breech, I let myself be talked into a c/s scheduled without attempting to move my big baby into position. REGRET. 1 minor exterior infection. 4th pregnancy! Babies (twins!) due 17.5 months after c/s.

    I live in a “all twins will be delivered via c/s – or at the very least on an OR table with an epi in place” town. (I am in Canada, I don’t expect you to have researched Cdn laws). My doctor said I was at 3-4% risk of rupture based on time length and that it is twins. I read your research on the one study saying it is 3% but that was with a 63% induction rate. My question? I am not sure, there are so many I suppose. Do the pros of my previous easy deliveries, my non emergency c/s, my fast labours, etc. help outweigh the time length issue? I am getting a 2nd opinion, but it seems all 5 ob’s in area feel the same…c/s are the fastest, easiest, safest way to delver babies.

    Also, I have read info on the death rate of babies from vbac, but what about the rate of birth/delivery defects IE: brain damage in a vbac baby. My ob is pulling out a lot of scare tactics and I just want to have the info to try and fight a little harder for what I want. I am sharing care with a midwife – but they legally can’t deliver twins, so they are only there for my prenatal care.

    Rambling message – sorry! And thank you once again.

    Jen

    • Jen Kamel

      Hi Jen!

      When your OB quotes a uterine rupture rate of 3-4%, I believe s/he is referencing Stamilio (2007) which found a rupture rate of 3.05% for women who got pregnant within 6 months of their cesarean. However, 68% of those women’s labors were induced or augmented, which, as you may know, substantially increases the risk of rupture. But that isn’t the only reason to take that statistic with a grain of salt. The fundamental problem with that study, as with all the studies I’ve read on rupture by birth intervals, is that they are way to small.

      You need about 5,000 women to accurately detect uterine rupture which multiple studies have found to be around 0.5%. For studies who wish to measure maternal and infant death, which happens even more rarely (especially maternal death), they need even more moms involved in order to accurately detect those even more rare events.

      Studies that small can just as easily return really low rates of UR as they can really high rates of UR. That is the fundamental problem with smaller studies.

      Stamilio does include over 5,700 women, but since they are comparing rates of rupture by various categories (0-6 months post CS vs. 6 – 11 months vs. 12 – 17 months vs. 60 or more), they need 5,000 women in each category in order to accurately detect UR per category. There were only 286 women included in the 0-6 months category. This is not nearly enough women. This study deserves to be replicated with more women in each category.

      As far as I know, all studies on birth intervals do not include 5,000 women by category. However, as this is the information we have available on the subject, let’s take a closer look at the Stamilio numbers and apply them to your situation.

      Your babies will be 17.5 months apart. Stamilio found a 3.05% rate of rupture among women who got pregnant within 0 – 6 months of their cesarean with 68% of those labors being induced or augmented. But you are on the cusp of that statistic. The rate dropped to 1.18% for women who got pregnant 6 – 11 months after their cesarean with 63% of those labors being induced or augmented. So, since your babies are almost 18 months apart, your risk is likely closer to 1.18% (and even lower if you aren’t induced or augmented). You can read more on birth intervals here where I include links to the full text of Stamilio’s study.

      You might want to bring a copy of Stamilio’s study into your next OB appointment to show him/her that you are closer to the 1.18% risk and stress that your risk, if you labor isn’t induced or augmented, will likely be much lower. Maybe your OB will be willing to give you a chance. Another factor is your OB’s experience with breech births as there is a good chance that at least one of your babies will be breech. If your OB does not sufficient education or experience with breech, that could also be impacting how s/he consuls you. You might want to ask your OB if that is a factor and if so, could s/he refer you to another OB who feels more comfortable attending breech births.

      In addition to your lower risk of rupture by birth interval, you have two other factors in your favor. First, your history of successful vaginal births means you have a “proven pelvis.” Women with a prior vaginal birth or VBAC have about an 80% success rates in subsequent VBACs.

      The second factor is the fact that your cesarean was for malpresentation. Women who have a cesarean for malpresentation have about an 80% success rate in future VBACS.

      Onto your second question regarding infant brain damage. I see your subsequent comment that you found the information you were looking for, but I just want to make sure you saw the Long Facts page (scroll down to Infant Outcomes) and also the “Infant Outcomes” category to your left.

      But the bottom line is, finding a VBAC supportive care provider is the #1 thing you can do to have a successful VBAC and it sounds like that, not the fact your baby will be born 17.5 months after your cesarean, is your major roadblock. Here are my recommendations. Get a copy of your medical records & operative report from your cesarean, get the names of VBAC supportive providers in your area (the farther you are willing to travel, the more options you will have), and ask the right questions .

      I wrote an article on planning a VBAC if you want to read more.

      I hope this helps!

      Warmly,

      Jen

  • Jen B

    Sorry, I DID read some more and found the stats for something happening to the baby.

  • Silvia

    Hi I was just wondering I has my first son in2005. By csection. Because he fell asleep on my sceptic nerve my second son was born in 2009 by the same obgyn he Waite til I was 8 months to tell me he didn’t do vbac so had another csection 4months later I found out. An pregnant again couldn’t find a dor to do a vbac I was also afraid bc my kids where so close together now I want to plan a fourth I would love to do a vaginal birth what would be the possibilities if I have good healthy pregnancies and had csection a due to not finding a doctor to do a vbac thanks for taking the time to respond

  • Hello Jen ,i was reading this site and makes me have more willing to have vbac delivery.Anyway this is my case or story , i had previous baby girl csection last August 6 2007 because my ob said i had no enough water inside due to hi blood pressure and i was 36 weeks that time. Now i am pregnant again my due date is on March 26 2012 i want to have vbac but my ob said she dont want me to take the risk of uterus rupture but i insist i want to try the vbac . Is there possibility that i can do it this time ? As had bikini cut scar.tell me please ur opinion thank u very much. My doctor now is chinese. And she was not my first doctor who did my c section . Pls reply asap thank u.. Jecelyn

  • Grace

    Thanks for compiling this information. It is very late in the game for me so I’m not sure if I will make it until you reply, but I just have to ask :)

    The long story:

    I had an emergency C-section 11/9/09. I went into labor in the middle of the night at 41 weeks and when we got to the hospital my son was having drastic decelerations with each contraction. Called a family member OB for second opinion and everyone agreed the baby needed to come out right away. I completely agree with the wisdom of the decision because my son had swallowed meconium and was very skinny, making us think the placenta was failing.

    Now I am pregnant and according to LMP calculations due April 30th, but according to early ultrasound measurements closer to April 23rd. So I am either overdue or almost due. My OB is the one who initially suggested I could VBAC, I didn’t even know it was an option for me. At this point the only risk factor not in my favor is the possibility that I might be overdue. My OB has said that a) he will not induce with pitocin. He would augment with pitocin if I went into labor on my own and stalled, basically as an alternative to RCS. He has also said that at the 41 week appointment, in his mind tomorrow the 30th, we would make a plan for a C-section this week. I have been having irregular contractions and pressure since the 24th, and a very small showing of blood on the 26th. No one has checked to see if I’m dilated or effaced.

    The short question:

    Are there studies about 1) the risk of using induction techniques for VBAC when you are past your due date, and 2) the risks of VBAC v. RCS to mother and baby past 41 weeks. Again, the confusion over the due dates is making me second guess the doctor’s advice, although otherwise I think he knows what he’s doing.

    • Jen Kamel

      Grace,

      Induction does increase the risk of rupture, but induction with Pitocin or foley catheter does remain an option per the American Congress of OBGYNS. You can read their latest VBAC recommendations as well as direct quotes about induction and going overdue.

      To read a review of the research, check out the Guise 2010 Evidence Report (go to page 45 of the PDF to read specifically about induction). Guise 2010 was prepared for the March 2010 National Institutes of Health VBAC Conference.

      You have all day today to read up! Hope this helps!

      Warmly,

      Jen

  • Renee

    I had a c section 8 months ago and am pregnant again. Never understood why the c section, no fetal distress pushed for 3 hrs. The op report did not give a reason so its speculated he was too big and to not attempt a vbac. Again no reason was listed in the rport. They suggested contacting the doc who delivered my son I had him in a different state. Will they even give me this information? My husband wants a vbac but he said fins out for sure.

  • Renee

    Hello Jen,
    Yes we got the operative report and it did not give a reason. The midwife I am seeing stated she thought it sounded like he would not fit because I pushed for 3 hours and was told to have a c section. She also advised it based on the fact that I was a GD the first time and have early GD the second time, however my son was average size last time, but she stated babies get larger with each pregnancy and said that if the first didn’t fit the second wouldn’t either and said she felt i would be better off not attempting a VBAC. I am not having my second baby here due to moving but my husband wants us to research so we can get a better answer other then based on speculation. The doc who delivered my son did make comments of she didn’t know why he wouldn’t decend and that she thought it could be becuase i was swelling alot vaginally. she even stated she wasn’t going to attempt to assist (not sure what she meant maybe forceps, or such? i don’t get why a doctor would be concerned) but short of that never understood why and again this wasn’t listed in the report. which the midwive thought was odd, other then maybe a page was missing. I called, but are they allowed to get this info to me over the phone?

  • Renee

    Update: They called back and stated even my chart did not indicate why it was needed it only stated i was coming in for an induction and that was it. They said would consult the doctor to see if they can help. So i’m guessing either someone messed up or i’m hitting a dead end apparently they are just as clueless.

  • Renee

    Finally got an answer, #1 was the gestational diabetes, #2 failure to descend (which confused me they said I stopped dilating, however I pushed for 3 hours…) and because my son was 7 12.2 they stated my son was too large (my midwive here says that’s average). I am having the report sent to me, and also the doc as a side note when speaking to the nurse today said her medical opinion was that I could attempt a VBAC but that all docs are different.

    Any other advice? I’m confused on the whole I stopped dilating but they had me push thing….

    • Jen Kamel

      Renee,

      I am not a medical professional, but if your OB who did your cesarean said you were a candidate for VBAC, I would trust that. Every birth is different. Just because you pushed for three hours and had a cesarean with your first, does not mean that will happen again. There are many variables at play during labor and delivery.

      Use the links I gave you above to find the names of VBAC supportive care providers that are in the area you are moving to. Then you can bring your medical records and operative report, ask them the questions I linked to above, and see what they think. I would talk to at least 3 to get an idea of their opinions and see whose policies you like better. As your OB said, all docs are different. This is key! So, shop around and pick a care provider who you like and trust based on their responses to the questions I link to above.

      Best of luck!

      Warmly,

      Jen

  • Laura

    Hi there, I love your site. I really enjoyed the Long Facts section and it was really helpful when I had the VBA2C discussion with my OB. I have had 2 C-sections. The first one was because I was a couple of days shy of 42 weeks and had only 1.5 cm amniotic fluid. They tried to soften the cervix with some gel for 24 hours, but nothing changed. I think I dilated to a 1 and I’m not sure about the effacing, but I was told I made no progress. At that point, my OB came in and said that he could start Pitocin, but it was his experience that under the circumstances, I’d end up with a distressed baby and a C-section. We chose not to try Pitocin and went straight for the C-section (mainly because it was my first one and I was terrified because I had read the risk of stillbirth goes up past 40 weeks, and my cousin had had a stillbirth at about 42 weeks even though the baby was still alive a little past her due date.) The second C-section was “elective.” I was told it was the only safe way to go after a C-section and I believed him. (My friend who moved to the area had had 1 C-section and 2 VBACs and she still had to call almost every OB office in town until she found one that would let her VBAC with her fourth child.)

    Now I’m about 39 weeks pregnant with my third. I changed OBs because my old one retired. The new one told me he would totally agree to a VBAC after one, but not after 2 sections. We scheduled the C-section for June 1, but a few weeks ago I started reading A LOT and found out that the risks of repeat C-sections are actually higher than VBA2C. I brought it up to him and told him I felt strongly about it, and he told me he was going to do some research and get back to me. The following appointment he was very optimistic and told me he had read about it and talked to his partners and they had agreed to a TOL. We moved the C-section back to the 8th, but he said that if the baby is doing fine, we’ll move it back some more to let me go into labor. He won’t induce labor, and honestly I don’t want him to either.

    Now here’s my question, I have gestational diabetes and the baby has been measuring a little large. Not too much though, but I fear that if I wait all the way to 42 weeks, she will be over 11 pounds. I’m petite and I’m afraid that might be too big. Is there anything that I can do to induce labor naturally that won’t increase risk of uterine rupture? I read about acupuncture, sex, foot massages, castor oil, etc., but I also read that if your body is not ready, pushing it might increase your risks. Is that correct? Is there anything at all I can do to increase my chances of a successful VBAC?

    • Jen Kamel

      Laura,

      < >

      I tend to agree with that. Generally, I think it’s best to wait for labor to start on its own. If your body is ready, some of those natural induction methods can kickstart your labor.

      Warmly,

      Jen

  • Sandra

    Thank you so much for this information! It has brought a lot of hope to my future as far as a VBAC is concerned. I am currently 10 weeks pregnant with my second child. I was so upset 3 years ago when the Dr told me I had to have a C-section. I was actually heartbroken. His reasoning? My daughter was estimated to be large. She was a big baby. 9lbs 15oz. From everything I have read, other Drs I have talked to and other mothers that are smaller/bigger than I am, I know now it was more out of convenience for him than it was for my safety. This time around, I am not taking no for an answer. Unless there is a true medically necessary reason, I want to have this baby as natural as possible. I’ve researched drugs that I could have on hold for pain if I decide I need them (I chose a low risk opiate) and I have been researching the benefits and risks of having a VBAC. From everything I have read, the benefits outweigh the risks. If I have to have a C-section this time around, I wont be too disappointed really, but I want the chance I wasn’t given last time. I wasn’t even allowed to go into labor with my daughter. I want that experience. For some reason, what they did to me made me feel like less of a woman. Like I am unable to do something that most mothers are capable of doing. I want that opportunity, and I am stubbornly going to go for it.

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